Healthcare Provider Details

I. General information

NPI: 1497280366
Provider Name (Legal Business Name): WELLMIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MARSH ST SUITE 108
SAN LUIS OBISPO CA
93401-2957
US

IV. Provider business mailing address

1411 MARSH ST SUITE 108
SAN LUIS OBISPO CA
93401-2957
US

V. Phone/Fax

Practice location:
  • Phone: 805-459-8232
  • Fax: 877-399-5883
Mailing address:
  • Phone: 805-459-8232
  • Fax: 877-399-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberG64445
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL DAVID MCGEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-459-8232